Pathology

Reactions to Natural Rubber Latex (NRL) affect all staff working in the Pathology because:

  • They have an increased risk of developing NRL allergy through the repeated use of NRL gloves.
  • They have a statutory responsibility to reduce risk of sensitisation in themselves, their colleagues and their patients.
  • They may need to manage sensitised patients.

All laboratory staff should ensure that they have and are familiar with:

  • An organisational Policy on action to protect staff who are allergic to NRL 
  • An organisational Policy on action to protect patients who are allergic to NRL 
  • An organisational purchasing programme which only supports powder-free/low-protein latex glove use and wherever possible NRL-free equipment and product purchasing 
  • Organisational and local Glove selection guides to minimise NRL and chemical exposure 
  • An organisational NRL-free resuscitation policy. ALL products must be latex free, as it makes no sense to use NRL when it may have been the cause of anaphylaxis. Click here for Resuscitation Council (UK) Guidelines. 
  • Occupational Health pre-screening questionnaires 
  • Risk-assessments undertaken for your specific department which must include NRL
  • A database of generic and specialty specific products which do and do not contain NRL which is regularly up-dated which needs to be specific for each department due to range of possible products used
  • Minimisation of purchase of NRL-containing products by checking with manufacturers ~ possibly labelled
  • A local or shared NRL-free trolley or box for use with sensitised patients
  • A Occupational Health/Health and Safety reporting mechanism for effective diagnostics of in-post staff
  • Synthetic alternative gloves for use by sensitised staff and for use with patients Glove materials
  • A named responsible person for managing Health and Safety

Allergic persons must be informed of reagents and equipment containing latex.

Glove Selection for Pathology Laboratories

Biohazard resistance and inoculation injury
Consider
When selecting gloves, which should be part of the COSHH Assessment for the use of any chemicals, some of the factors to be considered are:

  • The nature of the chemicals to which exposure might occur.
  • The concentration and/or temperature of the chemicals both of which can affect penetration rates.
  • The frequency and duration of contact with the chemical.
  • The requirement for the glove material to be robust and resistant to physical damage such as tearing or abrasion. or where inoculation injury risks exist, for example phlebotomy, contaminated machine probe manipulations etc.
  • The need for dexterity and "feel" with the glove on.
  • The extent of protection - hand only or wrist and forearm as well?

At the same time, gloves should not be used as a substitute for good experimental procedure which, as far as is practicable, should keep contamination well clear of all skin contact including hands.

Glove materials
Chemically resistant gloves come in a variety of materials such as natural rubber or latex, butyl rubber, neoprene, nitrile, polyethylene, PVC, PVA etc. sometimes in combination and in differing thickness and style. Each material protects well   against certain chemicals but poorly against others. The choice of material and its thickness depends on its resistance to permeation taking into account the factors listed above: - commonly, manufacturers' literature and performance tables have to be consulted to find this information.

Manufacturers' tables of glove performance often refer to the following indicators:

Breakthrough Time ~ the time, in minutes, for a measurable amount of chemical to pass through the glove material, one side of the glove being immersed in that chemical

Permeation Rate ~ Obvious meaning; - the units are milligrams per square metre per minute

Degradation ~ Loss of physical quality, perhaps becoming brittle or soft. May be measured as change in tensile strength after fixed periods of immersion

Useful Time ~ A parameter combining permeation and degradation data.

Disposable Gloves
Disposable gloves are often chosen for routine laboratory work because they are cheap and convenient. Unfortunately, the most popular choice, latex gloves are fully effective only against water-based solutions and are almost transparent to many organic solvents.

Nitrile disposable gloves may give more protection in certain cases.

Some Rules for Glove Use

  • Select gloves which are resistant to the chemicals you may be exposed to. Check the information sources listed below and also consult the relevant Material Safety Data Sheet (MSDS) which may recommend a particular glove material.
  • Select gloves of the correct size and fitting; gloves that are too small are uncomfortable and may tear whereas overlarge gloves may interfere with dexterity. In some cases, such as use of HF, it may be advisable to select gloves that can be removed very rapidly in an emergency.
  • Before use, check gloves (even new ones) for physical damage such as tears or pin- holes and for previous chemical damage: this is especially important when dealing with dangerous materials such as HF.
  • When working, it may be advisable to wash the external surface of the gloves frequently with water.
  • Some gloves, especially lightweight disposables, may be flammable: keep hands well away from naked flames or other high temperature heat sources. When removing gloves, do so in a way that avoids the contaminated exterior contacting the skin.

~ Wash hands after removing gloves.
~ Dispose of contaminated gloves properly.
~ Do not attempt to re-use disposable gloves.
~ Never wear possibly contaminated gloves outside of the laboratory or to handle
   telephones, computer keyboards, etc.

Links to sources of information about glove performance
Glove chemical resistance guides to help you choose disposable gloves to wear during different processes. Please note, the content of the list below in no way implies endorsement of the product produced by these companies. If any other such companies exist, please Contact Us so that they can be included in the list.

Another useful source of information on protective gloves is the California-Davis University website, that has Guidelines for the Selection of Chemically Resistant Gloves.


Reporting agencies for adverse reactions to Natural Rubber Latex products

  • The National Patient Safety Agency (NPSA) is a Special Health Authority charged with improving patient safety in the NHS.  It was created in 2001, following the publication of two reports addressing patient safety incidents in the NHS (An Organisation with a Memory and its follow-up, Building a Safer NHS for Patients).
     
  • The Medicines and Healthcare Products Regulatory Agency (MHRA) has a voluntary reporting system for reporting cases of NRL sensitisation in both patients and staff.